# Insights Into the Seroprevalence, Clinical Spectrum, and Laboratory Features of Dengue and Chikungunya Mono-Infections vs. Co-infections During 2022–2023

## TL;DR

This study examines the prevalence and clinical differences between dengue, chikungunya, and their co-infections in Central India, highlighting the importance of accurate diagnosis.

## Contribution

The study provides new insights into the seroprevalence and distinct laboratory features of dengue and chikungunya mono-infections and co-infections.

## Key findings

- Co-infections of dengue and chikungunya showed higher leucopenia compared to mono-infections.
- Hypokalemia was more prevalent in dengue and co-infected patients than in chikungunya patients.
- CHIKV patients had elevated urea and creatinine levels compared to others.

## Abstract

Background

Central India is hyperendemic for dengue and chikungunya virus infections, with yearly outbreaks being recorded. As these infections are clinically overlapping, co-infection of these viruses poses a diagnostic challenge. Therefore, it is imperative to identify them using serological or molecular tests. In this study, seroprevalence of dengue and chikungunya mono-infection as well as co-infections was estimated in suspected patients presented at our tertiary care center. Also, we compared the biochemical and other lab parameters of all the dengue and chikungunya mono-infected and co-infected IPD (Inpatient Department) patients.

Methods

A total of 3350 dengue and chikungunya suspected samples were recruited in this study. Sero-diagnosis of dengue was done using IgM MAC and NS‐1 antigen enzyme-linked immunosorbent assay (ELISA), and chikungunya by IgM MAC ELISA. Further, we compared the demographic characteristics, temporal variations, clinical features, and biochemical parameters in patients with dengue and chikungunya mono-infection vs. co-infection.

Results

Seropositivity for dengue (DENV) and chikungunya (CHIKV) mono-infections was observed to be 23.86% (n=800) and 13.30% (n=444), respectively, while seropositivity for dengue and chikungunya co-infections was observed to be 6.55% (n=220). Leucopenia was significantly higher among the co-infected patients as compared to DENV and CHIKV mono-infected cases. Hypokalemia was significantly higher among the DENV patients and co-infected patients as compared to the CHIKV patients. Urea and creatinine levels were significantly elevated among the CHIKV patients as compared to DENV and co-infected patients.

Conclusions

Leucopenia and hypokalemia were found to be significantly high among the co-infected patients. Clinically suspected samples should be tested for both viruses, especially in the monsoon and post-monsoon seasons, as high sero-prevalence has been observed. Simultaneous diagnosis of these infections is required to diagnose dual infections and thus triage patients for monitoring and initiating supportive treatment to prevent fatal complications.